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Patterns of Late GadoliniumEnhancement in Acute Myocarditis – does it make the difference?
Session:
Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker:
Sara Cristina da Silva Borges
Congress:
CPC 2021
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.3 Myocardial Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Sara Borges; José João Monteiro; Pedro Carvalho; Joaquim Chemba; Catarina Ferreira; j. Ilídio Moreira
Abstract
<p>Background Cardiac magnetic resonance (CMR) is used as a reference standard in the diagnosis of patients (pts) with acute myocarditis (AM) since it allows identifying myocardial damage non-invasively. The presence of late gadolinium enhancement (LGE) is associated with increased risk for adverse events but whether its location and pattern have clinical implications it is not completely established.</p> <p>The aim of this study was to determine the LGE distribution and correlate it with other myocardial damage indicators in AM patients.</p> <p>Methods Retrospective study of patients consecutively admitted with clinically suspected AM and fulfilling 2 or more CMR Lake Louise criteria, in one center, between January/2016 and September/2019.</p> <p>Results We included 35 patients (32±12 years, 94% males; 54% smokers). The mean length of hospital stay was 6 ± 3 days. The vast majority (94%) presented subepicardial LGE – being the inferior wall the most frequently involved (64%), (followed by inferolateral 61%, anterolateral 52%, anterior 51%; involvement of the septum was present in only one patient). The distribution of LGE enabled the identification of 3 main patterns: IFL: inferior + inferolateral wall (43%); AL: anterior + anterolateral wall (36%) and M: mixed pattern (21%);</p> <p>At admission, clinical presentation was similar in all groups, being chest pain the most common symptom. The mean number of segments involved was 4.8 ± 1.6 and was not different between the groups (p=0,356). Analysis by pattern of LGE distribution didn´t show significant differences. However, analysis by wall revealed that the presence of LGE in the anterior wall, irrespectively of the pattern, was associated with higher end diastolic volumes, higher NT-proBNP and peak troponin levels (all p<0.05). No significant differences regarding inflammatory parameters were found. Ejection fraction and cardiac output tend to be lower, even if this difference is not statistically significant. In univariate analysis, only the presence of LGE in anterior wall was a predictor of in-hospital non-fatal arrhythmic events (OR 6,2, CI95% 1,1,-36,2;p= 0.042).</p> <p>Conclusion Not all LGE patterns seen in acute myocarditis are equivalent, and patients with anterior wall LGE seem to have more myocardial damage, regardless of the number of segments affected or pattern. Long term follow up is warranted to asses prognostic implications of this finding.</p>
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